Free bus tickets aim to reduce no-shows by addressing transportation barriers

Context: Missed medical appointments without cancellation (no-shows) negatively affect the flow of patient care and clinic productivity. Limited evidence is available about effective interventions to reduce no-show appointments by addressing patient transportation barriers.

Objective: 1) explore patient response to free bus tickets for medical appointments, 2) identify other factors contributing to no-show appointments.

Study Design: Prospective cohort and mixed methods study.

Setting: October 2020-July 2021 at an urban ambulatory family health center.

Population Studied: Eligible participants included patients who presented to the community health center for any type of medical appointments, who consented to answer a brief qualitative questionnaire and who screened positive for transportation issues. Two standardized screening questions: Has lack of transportation interrupted medical needs in the past 12 months? Has lack of transportation interrupted daily activities in the past 12 months.

Intervention: Participants received two free bus tickets to defer transportation costs.

Outcome Measures: Main) Patient perceptions of ticket usefulness. Secondary) Themes of other contributing factors for no-shows.

Results: 108 patients participated in this study, and 88.9 % (96/108) of participants reported having a bus ticket helps them keep medical appointments; 82.4 % (89/108) reported having a bus ticket influences their decision to come to the health center. Of those who have missed prior appointments without cancellation, 71.7 % (38/53) reported transportation issues as potential factors contributing to no-shows. Finances was the second most common self-reported theme: 18.9 % (10/53). Comments from participants: “If I cannot get a ride, sometimes I will cancel.”, “The bus tickets help me a lot.”, “I think it’s a great and very helpful thing. Getting transportation is not easy.”, “This is a good thing to do. Thank you.”, “I usually walk. Having bus tickets helps me a lot.”

Conclusions: This study provides insight into patient experiences related to no-show appointments. Free bus tickets can reduce no-shows by addressing patient financial or/and transportation issues for coming to the health center. The effect of travel assistance on no-show rates among patient populations at a community center should be further explored. This study was impacted by the COVID-19 pandemic regarding the fear of the public transportation and increased telemedicine visits.